One Year in, D-H and Mayo Clinic See Promise in Partnership

Lebanon — It’s been a year of foundation-building for Dartmouth-Hitchcock and the Mayo Clinic, 12 months of laying the groundwork in a formal partnership that hospital officials believe could be a model for other providers navigating radical changes in the health care industry.

In July 2012, when Dartmouth-Hitchcock announced it would be joining the Mayo Clinic Care Network, officials spoke of the benefits to patients and physicians from having access to the expertise at one of the nation’s most respected health care leaders. In joining the network, Dartmouth-Hitchcock would be able to consult with Mayo doctors in treating patients, conducting research, training staff and even share business practices.

The progress to date has been slower than some expected, and much of the work has happened outside of clinical care. But Dartmouth-Hitchcock officials said Thursday that the experience has shown promising signs for how regional hospitals can collaborate to improve the quality and efficiency of care, while also staying independent.

“There’s real value to patients here,” said Gregg Meyer, chief clinical officer and executive vice president for population health at Dartmouth-Hitchcock. “We’re just starting to see it. It takes time to develop the tools and make this relationship work. There’s time to embed it in our electronic health record. But it’s now starting to pay some dividends.”

Dartmouth-Hitchcock is one of 20 organizations included in the Mayo Clinic Care Network, which gives health care providers access to some of the tools and resources at the Rochester, Minn.-based health care system. The nonprofit provider is among the largest health care systems in the U.S., with more than 61,000 physicians, medical residents, students and staff, and treating more than a million people from around the world every year.

Although Dartmouth-Hitchcock has long had ties with Mayo — the D-H clinic was established in 1927 using Mayo as a model — the collaboration announced last year was intended to deepen that relationship, one in which they’d share research expertise, practical knowledge for providing care and best practices for managing a large hospital system.

Dartmouth-Hitchcock pays Mayo a fee for network membership, an amount of money that both are keeping confidential. There are no extra costs to patients. But the work to date and the prospects for future collaboration on telehealth initiatives, patient consultations and research has yielded enough value to convince Dartmouth-Hitchcock officials that the investment is worthwhile.

Since the collaboration began, Dartmouth-Hitchcock has “had an opportunity for some very practical learning,” Meyer said. For example, it has consulted with Mayo experts on the nuts and bolts of how to help doctors use telehealth technology, allowing them to deliver remote care to patients who live in the most rural parts of the Twin States.

Dartmouth-Hitchcock is also using the partnership to improve care for stroke patients. The hospital doesn’t have enough stroke neurologists to be available 24 hours a day, seven days a week. In cases when no one else is available, Mayo doctors are on hand to offer “wrap around” coverage and consult with an emergency department physician remotely.

There have also been some opportunities for patients to get a second opinion from Mayo doctors, free of charge, Meyer said.

“But more importantly, (patients) don’t get in a car and drive down 89” to another hospital in Boston, Meyer said. “They don’t disrupt their family. It offers an extension of what we’re able to do here. And frankly, it also allows us to keep care in the region that ought to be kept in the region.”

Keeping care regional is one of the ancillary benefits of these kind of partnerships, and offers a counter vision to the consolidation that is happening in health care lately, said David Hayes, medical director of the Mayo Clinic Care Network.

Hospital mergers are happening at the fastest rates since the 1990s, consolidations that are being driven by the Affordable Care Act, lower federal reimbursements and declining patient admissions, according to a story last week in The New York Times. Some health care experts predict that 1,000 of the nation’s 5,000 hospitals could seek out mergers in the next five to seven years, according to the Times, leading to mega health care networks that could stretch coast to coast.

“Who knows where health care in the United States will land?” Hayes told the Valley News Wednesday. “Some visionaries are forecasting down the road, we’ll end up with a limited number, maybe 10 or 20 very large health care systems in the United States and that there will be fewer and fewer independent organizations. We think there’s real value in regional organizations staying regional and staying healthy and independent. And if this sort of collaborative network helps strengthen each other and strengthen other organizations to keep them independent, we actually think that’s preferable to large scale mergers and acquisitions.”

Hayes acknowledged that the partnership with Dartmouth-Hitchcock has seemed slow to unfold as each institution works to understand how the other is organized and adjusts.

“I’m by nature impatient, but it has been a little slower getting information diffused across both organizations,” Hayes said. “But I think we’ve had some real success in certain service lines and we hope to expand those interactions.”

Besides offering additional resources to patients and doctors, there have been opportunities for education and research, said Rich Rothstein, chairman of Dartmouth-Hitchcock Medical Center’s Department of Medicine.

“How do we train people in our simulation center and looking at what’s happening in our value institute?” he said. “What can we learn from each other?”

Likewise, Hayes said there are aspects of the curriculum at Dartmouth’s Geisel School of Medicine that “Mayo Medical School would very much like to adopt.”

These initiatives are still very early on, Hayes said. The next year should bear the fruit of the foundation building that has happened since July 2012.

But exactly what kind of fruit this work bears is still a mystery, Meyer said.

“I don’t know what that’s going to be,” he said, “and in many ways, that’s what is exciting about it.”

To set specific expectations for the partnership would be not only impossible, but foolish, Hayes said. Health care is changing rapidly. The rollout of health insurance exchanges, expanded use of technology and electronic medical records, and experiments happening in states like Vermont, which is moving to a single-payer system, could steer the direction of the relationship.

“Hopefully the relationship will continue to grow and evolve,” Hayes said. “I don’t think it will ever be static. I think if it becomes static, then we’ve got a problem, because in medicine and especially with health care changing as much as it is, nothing is static. I think this will be a dynamic relationship where we bring new tools to the network. We figure out how to exchange knowledge and expertise. It will be a little different every year.”